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Psychiatry > Psychosis > Flashcards

Psychosis Flashcards

1
Q

what is the neuroanatomical findings in psychosis?

A

reduction in grey matter volume

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2
Q

what is the pathophysiology associated with hallucinations?

A

DEMONSTRATE INCREASED ACTIVITY IN PRIMARY OR SECONDARY SENSORY CORTICES (left middle temporal, left superior temporal and left inferior frontal)

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3
Q

what is the pathophysiology associated with delusions?

A

linked to dopamine – overactivity in mesolimbic pathway, NMDArep dysfunction

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4
Q

what are the different classes of psychosis?

A
  • Drug induced
  • Depressive psychosis
  • Mania with psychosis
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5
Q

what delusions are present in depressive psychosis?

A

delusions of worthlessness, hallucinations accusing

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6
Q

what delusions are present in psychosis with mania?

A

delusions of grandeur

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7
Q

what are the psychiatric disorder differentials to psychosis?

A

schizophrenia, bipolar, schizoaffective disorder, depression with psychotic features brief psychotic disorder, delusional disorder, dysmorphophobia, morbid jealousy, erotomania

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8
Q

what are the drug causes of psychosis?

A

dextromethorphan, antihistamines, medications containing phenylpropanolamine, anticholinergics, dopamine agonists, corticosteroids, adrenergic, thyroid hormone, cocaine, cannabis, amphetamines, phencyclidine, alcohol, inhalants

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9
Q

what are the neurological disorder differentials to psychosis?

A

epilepsy, traumatic brain injury, ms, brain tumour, dementia, fahrs disease, dementias

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10
Q

what are the infective differentials to psychosis?

A

manifestation of encephalitis – stds, measles, mumps, ebv, rabies

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11
Q

what are the vitamin deficiencies differentials to psychosis?

A

folate, vitamin b12, niacin, chronic thiamine

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12
Q

what are the endocrine differentials to psychosis?

A

thyroid dysfunction, cushing’s, thymoma, hyperparathyroidism

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13
Q

what are the autoimmune differentials to psychosis?

A

thyrotoxicosis, coeliac, haemolytic anaemia, active hepatitis, interstitial cystitis, myositis, polymyalgia rheumatica, sjogren’s, lupus

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14
Q

what are the metabolic differentials to psychosis?

A

schizophrenia, schizoaffective disorder, brief psychotic disorder, schizophreniform disorder, depression with psychotic features, bipolar disorder, delusional disorder, shared psychotic disorder.

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15
Q

what are the chromosomal disorder differentials to psychosis?

A

klinefelter’s, digeorge syndrome, prader willi syndrome

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16
Q

what are the clinical features of psychosis?

A 
Hallucinations
Ideas of Reference
Delusions
Formal Thought disorder
Thought interference
Passivity phenomena
Loss of insight 
Delirium
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17
Q

what are hallucinations?

A

a perception which occurs in the absence of an external stimulus

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18
Q

what are the different types of hallucinations?

A

Auditory - second and third person
visual
others - olfactory, gustatory, tactile, haptic
Simple or complex

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19
Q

what are ideas of reference?

A

innocuous or coincidental events will be ascribed significant by the person
Paranoia

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20
Q

what are the features of ideas of reference?

A

 believe events are about/involve them – radiobroadcasts are about them, objects trying to send them a message

21
Q

what is paranoia?

A

 the belief that external events are related to oneself

 can vary in intensity from a brief thought, to frequent & intrusive thoughts to delusional intensity

22
Q

what is a delusion?

A

a fixed, falsely held beliefs

23
Q

what are the different types of delusion?

A

paranoid, persecutory, grandiose, religious, misidentification, guilt, sin, poverty, nihilistic (normally in depressive illness), of love, jealously

24
Q

what are the different types of thought disorder?

A

neologisms, circumstantial tangentiality, clanging and punning, loosening of associations, knights move thinking, verbigeration/word salad

25
Q

what are the different types of though interference?

A

insertion, withdrawal, broadcasting, blocking

26
Q

what is the passivity phenomena?

A

not having a sense of own movements and actions – being controlled

27
Q

what are the features of appearance & behaviour in and MSE of psychosis?

A

may show self neglect, restlessness or odd, or lack of movements, and odd appearance(e.g. hair / makeup / clothes)

28
Q

what are the features of appearance & behaviour in a MSE of psychosis?

A

may show self neglect, restlessness or odd, or lack of movements, and odd appearance

29
Q

what are the features of speech in a MSE of psychosis?

A

Tangential speech – one though is unrelated to the next. Often neologisms, may be incoherent, jumps from subject to subject

30
Q

what are the features of Mood in a MSE of psychosis?

A

suspicious, may often seem deep in though and perplexed/confused

31
Q

what are the features of Thoughts in a MSE of psychosis?

A

delusions, though disorder, persecutory

32
Q

what are the features of perception in a MSE of psychosis?

A

hallucinations – most commonly auditory

33
Q

what are the features of cognition in a MSE of psychosis?

A

poor attention span and concentration, unshakable beliefs (‘concrete thinking’)

34
Q

what is the management of psychosis?

A
  • Require admission

* Atypical Antipsychotics 1st Line

35
Q

what is the epidemiology of schizophrenia?

A

male>females

male younger onset

36
Q

what are the causes of schizophrenia?

A
  • Genetic
  • Birth Complications – prematurity, fetal distress/hypoxia
  • Neonatal infections
  • Autoimmune disease
  • Events – increased stress, intense emotions, criticism
  • Drugs – particularly hallucinogens, stimulants, including amphetamines, alcohol and cannabis
37
Q

what are the positive symptoms of schizophrenia?

A 
Hallucinations, Delusions
Passivity phenomena
Thought disorder
Appearance and behaviour - preoccupied, withdrawn, inactive, restless, noisy, inconsistent)
Speech neologisms,
Mood (blunting, incongruity)
Orientation -normal,  Attention - impaired, 
Memory (normal)
Insight (impaired)
38
Q

what are Schneider’s first rank symptoms of schizophrenia?

A

delusion, delusional percept, auditory hallucinations, audible thoughts voices arguing or discussing, voices commenting on the patients actions, thought disorder: passivity of thought, thought withdrawal, thought insertion, thought broadcasting, passivity of affect, passivity of impulse, passivity of volition, somatic passivity

39
Q

what are the negative symptoms of schizophrenia?

A

Lack of drive and activity, social withdrawal, abnormalities of behaviour, stupor and excitement, abnormal movements, abnormal tonus, speech (reduced in amount, evidence of thought disorder), mood disorder (blunting, incongruity, depression), hallucinations (especially auditory), delusions (systematised, encapsulated), orientation (age disorientation), attention (normal), memory (normal), insight (variable), hypomimia (lack of facial expression), blunted affect, no facial expression), unkempt

40
Q

what are the cognitive changes in schizophrenia?

A

subtle changes in memory, learning, understanding

41
Q

what are the 3 phases of schizophrenia?

A

o Prodromal – withdrawn
o Active – severe symptoms
o Residual – cognitive symptoms

42
Q

ICD criteria of schizophrenia includes least one of:

A

o thought echo, thought insertion or withdrawal, and thought broadcasting;
o delusions of control, influence, or passivity, clearly referred to body or limb movements or specific thoughts, actions, or sensations; delusional perception;
o hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing the patient among themselves, or other types of hallucinatory voices coming from some part of the body;
o persistent delusions of other kinds that are culturally inappropriate and completely impossible, such as religious or political identity, or superhuman powers and abilities (e.g. being able to control the weather, or being in communication with aliens from another world);
o persistent hallucinations in any modality, when accompanied either by fleeting or half-formed delusions without clear affective content, or by persistent over-valued ideas, or when occurring every day for weeks or months on end;

43
Q

ICD criteria of schizophrenia includes least two of:

A

o breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech, or neologisms;
o catatonic behaviour, such as excitement, posturing, or waxy flexibility, negativism, mutism, and stupor;
o “negative” symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses, usually resulting in social withdrawal and lowering of social performance; it must be clear that these are not due to depression or to neuroleptic medication;
o a significant and consistent change in the overall quality of some aspects of personal behaviour, manifest as loss of interest, aimlessness, idleness, a self-absorbed attitude, and social withdrawal.

44
Q

what is the management of acute psychosis?

A

1st episode – ensure safety, consider oral benzodiazepine, referral for antipsychotic

45
Q

what is the 1st line management of ongoing schizophrenia?

A

2nd generation (atypical)

46
Q

what is the 2nd line management of ongoing schizophrenia?

A

another atypical or typical

47
Q

what is the 3rd line management of ongoing schizophrenia?

A

clozapine

48
Q

what psychosocial interventions are also used in the management of CBT?

A

CBT

Psychiatry (11 decks)

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